XPS Greenlight^© photoselective vaporisation for benign prostatic hyperplasia: Learning curve and contribution of transrectal ultrasound monitoring

Introduction: The aim of this study was to analyze the XPS^© laser learning curve of one single surgeon with no previous experience of PVP and the impact of the use of reel time transrectal ultrasound (TRUS) monitoring. Materials and methods: Retrospective analysis of the first 100patients: group 1 (1st-49th patient without TRUS) and group 2 (50th-100th with TRUS). The learning curve was analyzed through technical variables: vaporization time/intervention time (VT/IT) (%), energy delivered (J)/prostate volume (J/mL) and delivered energy (J/s or Watt), peroperative conversion into monopolar transurethral resection, postoperative complication, duration of catheterization and hospitalization and evolution of International Prostate Symptom Score (IPSS), PSA level, prostate residual volume and Qmax. Relationships between variables were evaluated by analysing the covariance (R 2 software. 14.2). Results: A significant increase in VT/IT ( P=. 0.0001) and the energy delivered per mL prostate ( P=. 0.043) was reported in group 1. The average energy delivered per second was significantly higher in group 2 ( P=. 0.0016). No difference was observed in terms of intra- or postoperative complication and catheterization time. The duration of hospitalization was significantly shorter in group 2 ( P=. 0.03). The use of TRUS was associated with a gain of energy delivered by prostate volume at the end of learning curve ( P=. 0.018). Prostate residual volume was significantly lower in the group 2 ( P=. 0.0004). Conclusion: In our experience, 50 procedures are required to achieve the learning curve of PVP. The use of reel time TRUS would increase the energy delivered by prostate volume.